COUGH

COUGH
Cough is an explosive expiration
that provides a normal protective
mechanism for clearing the
tracheobronchial tree of
secretions and foreign material
(Harrisons Principles of Internal Medicine, 17th Edition)
COUGH
Common symptom that ranges in significance
from trivial to ominous.
Typically, cough is a reflex response to stimuli
that irritate receptors in the larynx, trachea, or
large bronchi
These stimuli include mucus, pus, and blood, as
well as external agents such as dusts, foreign
bodies, or even extremely hot or cold air
( BATES Guide to Physical Examn and History Taking, 9th Ed)
COUGH
Medical Name: Tussis
COUGH
Associated Terms:
1. Acute Cough
- <3 weeks, is most often due to upper
respiratory infection (especially the common cold,
acute bacterial sinusitis, and pertussis),
- But more serious disorders, such as
pneumonia, pulmonary embolus, and congestive
heart failure, can also present in this fashion
(Harrisons Principles of Internal Medicine, 17th Edition)
COUGH
2. Subacute Cough
- Between 3 and 8 weeks, is commonly
post-infectious, resulting from persistent
airway inflammation and/or postnasal drip
following viral infection, pertussis, or infection
with Mycoplasma or Chlamydia
(Harrisons Principles of Internal Medicine, 17th Edition)
COUGH
3. Chronic cough
- >8 weeks in a smoker raises the
possibilities of chronic obstructive lung
disease or bronchogenic carcinoma.
- In a nonsmoker who has a normal chest
radiograph and is not taking an ACE inhibitor,
the
COUGH
- Most common causes of chronic cough are
postnasal drip (sometimes termed the
upper airway cough syndrome) , asthma,
and gastroesophageal reflux.
- Eosinophilic bronchitis in the absence of
asthma has also been recognized as a
potential cause of chronic cough
COUGH
4. Hemoptysis
- Defined as the expectoration of blood
from the respiratory tract, a spectrum that
varies from blood-streaking of sputum to
coughing up large amounts of pure blood
(Harrisons Principles of Internal Medicine, 17th Edition)
COUGH
Associated Terms:
5. Sputum
- Expectorated matter from the air passages
( Mellonis Illustrated Medical Dictionary)

- Saliva mixed with mucus coughed up from

the respiratory tract
(Concise Medical Dictionary)
COUGH
Associated Terms:
6. Mucoid sputum
- Translucent, white, or gray
7. Purulent sputum
- Yellowish or greenish
( BATES Guide to Physical Examn and History Taking, 9th Ed)
COUGH
Associated Terms:
8. Dry Cough
- cough without phlegm
9. Whooping Cough
- an infectious bacterial disease that
causes violent coughing spasms followed by
sharp, shrill inhalations. It mainly affects
children
- Caused by Bordetella pertussis
COUGH
Associated Terms:
10. Asthma
- A disease of the respiratory system,
sometimes caused by allergies, with
symptoms including coughing, sudden
difficulty in breathing, and a tight feeling in
the chest
COUGH
11. Wheezes
- are musical respiratory sounds that
may be audible both to the patient and to
others
( BATES Guide to Physical Examn and History Taking, 9th Ed)

12. Tuberculosis
- an infectious disease caused by the
bacillus Mycobacterium tuberculosis and
characterized by the formation of nodular
lesions in the tissues
( Consise Medical Dictionary)
MECHANISM OF COUGHING

A.DIFFERENT TYPES OF COUGH STIMULI

Exogenous source
Smoke

Dust

Fumes

Foreign bodies
MECHANISM OF COUGHING
A.DIFFERENT TYPES OF COUGH STIMULI
Endogenous origin
Upper airway secretions

Gastric contents
MECHANISM OF COUGHING
These stimuli may affect receptors in
the upper airway (especially the
pharynx and larynx) or in the lower
respiratory tract
Following access to the
tracheobronchial tree by inhalation or
aspiration
MECHANISM OF COUGHING
Afferent limb includes receptors
within the sensory distribution of the
trigeminal, glossopharyngeal,
superior laryngeal, and vagus
nerves
MECHANISM OF COUGHING

Efferent limb includes the

recurrent laryngeal nerve and
the spinal nerves
MECHANISM OF COUGHING
When cough is triggered by upper airway
secretions (as with postnasal drip) or gastric
contents (as with gastroesophageal reflux)
Initiating factor can go unrecognized and the
cough may persist
MECHANISM OF COUGHING
Prolonged exposure to such irritants may
initiate airway inflammation,
Which can itself precipitate cough and
sensitize the airway to other irritants
MECHANISM OF COUGHING
Cough associated with gastroesophageal
reflux
Is due only in part to irritation of upper airway
receptors or to aspiration of gastric contents
As a vagally mediated reflex mechanism
secondary to acid in the distal esophagus
may also contribute
MECHANISM OF COUGHING
Any disorder resulting in inflammation,
constriction, infiltration, or
compression of airways can be
associated with cough
Inflammation commonly results from
airway infections, ranging from viral or
bacterial bronchitis to bronchiectasis
MECHANISM OF COUGHING
In viral bronchitis
Airway inflammation sometimes persists long
after resolution of the typical acute symptoms
Thereby producing a prolonged cough that
may last for weeks
MECHANISM OF COUGHING
Pertussis infection is also a possible
cause of persistent cough in adults;
however, diagnosis is generally made
on clinical grounds
Asthma is a common cause of
cough
MECHANISM OF COUGHING
A neoplasm infiltrating the airway wall, such
as bronchogenic carcinoma or a carcinoid
tumor, is commonly associated with cough.
Airway infiltration with granulomas may
also trigger a cough, as seen with
endobronchial sarcoidosis or
tuberculosis
MECHANISM OF COUGHING
Parenchymal lung disease potentially producing
cough
Interstitial lung disease
Pneumonia

Lung abscess
MECHANISM OF COUGHING
Congestive heart failure may be associated
with cough
(probably as a consequence of interstitial as well as peribronchial
edema)

A non-productive cough complicates the

use of angiotensin-converting enzyme (ACE)
inhibitors in 520% of patients taking these
agents